Living donor kidney transplantation in the hemodialysis-naive and the hemodialysis-exposed: A short term prospective comparative study

Introduction

Preemptive (P) living donor kidney transplantation (LDKT) provides better survival rates, quality of life and economic saving. However, the extent of these advantages over those with a short period of pre-LDKT dialysis is not known.

Objectives

Evaluation of the patients’ characteristics and short-term outcomes of PLDKT and LDKT after a pre-transplant period of hemodialysis (HD) not >6 months.

Patient and methods

This study was conducted between June 2010 and June 2012 and included two groups. Group-I included recipients without HD before operation. Group-II included those who had a period of HD ≤6 months. Recipients and donors were evaluated according to the classic work up.Follow-up for 12 months was scheduled.

Results

Group-I included 30 recipients and group-II included 15 recipients. Demographic and clinical characteristics were similar except for mean recipient age (44 versus 34.3 years; p = 0.024), recipient donor age difference (p = 0.03), job categories (p = 0.047) and ABO distribution (p = 0.01). Cumulative graft (0.88 versus 0.93) and recipient (0.92 versus 0.100) survival rates were non-significantly different. Graft function and mean serum creatinine level were within normal up to 12 months. Acute graft rejection (AGR) was significantly higher in group-II (16.7% versus 46.7%; p = 0.03). However, lymphoceles were significantly more common in group-I (40% versus 6.7%; p = 0.02). There was no delayed graft function (DGF), major urinary or vascular complications.

Conclusion

PLDKT has a lower rate of AGR. Despite it has a higher rate of lymphoceles, it saves the patient the morbidities of vascular access and inconveniences of HD. Hence, PLDKT is recommended as the first choice for each KT-candidate.